ORDERED BY:	SHIP TO: (if different)
Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail

USE A SEPARATE ORDER FORM FOR EACH DOLL ORDERED

Sex	Male Female
First Name		Month of Birth
Middle Name		Date of Birth
Eye Color	Blue  Green  Hazel Brown  Grey  Violet	Day of Week
Hair Color	Blond  Carrot Red   Auburn  Brown  Black	Hour of Birth
Hair Shade	Pale Light Medium Dark	Minute	AM PM
Order Total	$ US Funds	CUSTOM ORDERS	*Custom Order Girl* *Custom Order Boy*
50% Deposit	$ US Funds	Payment	Check  Money Order Credit Card - PAYPAL

                *CUSTOM ORDERS*: request price quote in advance.  Attach separate sheet with detailed instructions, drawing or photo.
                Credit Card Payments accepted through Secure Internet Site - https://www.paypal.com 

Print Order Form and send with photo/s to:        

Steele Originals  *  P.O. Box 31  *  Leetonia, OH 44431      

Phone: 330-502-5563